DEAR DR. ROACH: I’m a 66-year-old man who has had two strokes in two years. The surgeon said that what caused the strokes both times is that arteries that supply blood to my brain are too small. The surgeon said brain surgery was too dangerous. All he did was change my meds. My concern is whether this treatment is enough to prevent another stroke. I’m afraid I may have a third and final stroke! Dr. Roach, are there any other treatments available? Can this problem be helped with stents or stem cells? — J.B.
ANSWER: A stroke is very similar to a heart attack. Not enough blood flows to the brain, and some of the brain cells die, and the brain forms a scar. Depending on how much and what part of the brain is affected, the effect can be anywhere from unnoticeable to devastating. A TIA (transient ischemic attack) is similar to a stroke, except that symptoms last less than 24 hours, and it is thought to be from poor blood flow but without the resulting death of the brain cells.
Treatment for an acute stroke, like a heart attack, should be done as quickly as possible in the hospital. Many people permanently lose brain function by not calling an ambulance right away when experiencing stroke symptoms, such as sudden weakness or difficulty speaking.
As for treatment to prevent stroke in someone who has had a previous stroke or TIA, both medications and surgery sometimes are used. However, medications are used more and more, so there are fewer people getting surgery. If your surgeon says surgery isn’t for you, then you are left with medications. Fortunately, these are much better at preventing stroke than they used to be.
Stents have been tried but have not been successful. I have read preliminary data on stem cells being used for acute stroke, but I don’t know of any results from using stem cells to prevent stroke.